Metanol zehirlenmesi olan hastalarda mortalite ile ilişkili risk faktörleri: retrospektif bir çalışma

Year 2022, Volume: 6 Issue: 3, 293 - 300, 31.12.2022

Hakan Aydın , Fatih Doğanay , Mehmet Erdoğan , Halil Doğan , Attila Beştemir , Alpay Tuncar

https://doi.org/10.30565/medalanya.1184894

Cited By: 1

Abstract

Amaç: Metanol zehirlenmesi (MZ) dünya çapında önemli bir tıbbi sorundur, tanı ve tedavideki gelişmelere rağmen bu vakalarda ölüm oranı yüksektir. Bu çalışmada MZ olan hastalarda hastane içi mortaliteyi öngörmek için klinik ve laboratuvar faktörlerinin değerlendirilmesi amaçlandı.

Yöntemler: Bu tek merkezli, retrospektif, gözlemsel çalışma, 01 Ocak 2017 ve 01 Şubat 2022 tarihleri arasında üçüncü basamak bir eğitim ve araştırma hastanesinin acil servisini (AS) ziyaret eden yetişkin 65 MZ vakası ile yürütülmüştür. Veriler hayatta olanlar ve hayatta olmayanlar arasında istatistiksel olarak karşılaştırıldı.

Bulgular: Hastane içi ölüm oranı %41,5 idi. Hayatta kalmayanlar grubunda solunum sıkıntısı, düşük GKS (≤8), ve hastaneye geç başvuran (24 saaten sonra) vakalarının oranı, hayatta kalanlar grubuna göre daha yüksekti. Ölen hastaların grubunda yaşayanlara kıyasla daha yüksek anyon açığı (30,5 mEq/L vs. 25,5mEq/L), baz fazlalığı (-25,0 mmol/L vs. -18,6 mmol/L), laktat seviyeleri (10,2 mmol/L vs. 2,2 mmol/L) ve daha düşük pH (6,76 vs. 7,14) ve bikarbonat (6,3 mmol/L vs. 10,3 mmol/L) seviyeleri vardı (p<0.001). ROC analizinde pH (AUC= 0,916) ve baz fazlalığı (AUC=0,915), MZ olgularında mortaliteyi öngörmede en yüksek AUC değerlerine sahip kan gazı parametreleriydi. Tedavide folat kullanımının mortalite üzerinde istatistiksel olarak anlamlı bir etkisi oldu (p=0.015). Tedavide folat kullanımının mortalite üzerinde istatistiksel olarak anlamlı bir etkisi oldu (p=0.015).

Sonuç: MZ olgularında hastaneye başvuruda geçikme, şiddetli metabolik asidoz, yüksek laktat düzeyleri, acil servise gelişte düşük GKS ve folat tedavisiverilmemesi, artan hastane içi mortalite oranları ile ilişkiliydi. Verilerimiz MZ hastalarının klinik yönetimine ve tedavi protokollerinin geliştirilmesine katkıda bulunacaktır

Keywords

Methanol, Folik asid, Asidoz, Anyon açığı, Alkol zehirlenmesi

Supporting Institution

Yok

Project Number

Yok

Thanks

Yok

Risk factors associated with mortality in patients with methanol poisoning: a retrospective study

Abstract

Aim: Methanol poisoning (MP) is an significant medical problem worldwide, and despite advances in diagnosis and treatment, the mortality rate in these cases remains high. This study aimed to evaluate the clinical and laboratory factors to determine in-hospital mortality in patients with MP.

Methods: This single-center, retrospective, observational study was conducted with 65 adult MP cases visiting the emergency department (ED) of a tertiary training and research hospital, between January 01, 2017 and February 01, 2022. Data was statistically compared between survivors and non-survivors.

Results: The in-hospital mortality rate was 41.5%. The rate of cases with respiratory distress, low Glasgow coma scale (GCS) (≤8), and delayed arrival to the hospital (>24 hours) was higher in the group of non-survivors compared to the group of survivors. Non-survivors had a higher anion gap (30.5 mEq/L vs. 25.5mEq/L), base excess (-25.0 mmol/L vs. -18.6 mmol/L), lactate (10.2 mmol/L vs. 2.2 mmol/L) levels, and lower pH (6.76 vs. 7.14) and bicarbonate (6.3 mmol/L vs. 10.3 mmol/L) levels than survivors (p<0.001). In ROC analysis, pH (AUC= 0.916) and base excess (AUC=0.915) were blood gas parameters with the highest AUC values in predicting mortality in MP cases. Folate use in the treatment had a statistically significant effect on mortality (P=0.015).

Conclusion: In MP cases, delay in a hospital visit, severe metabolic acidosis, high lactate levels, low GCS on arrival to the ED and no folate therapy, were associated with increased in-hospital mortality rates. Our data will contribute to the clinical management of MP patients and the development of treatment protocols.

Keywords

Methanol, Folic Acid, Acidosis, Anion gap, Alcoholic Intoxication

Project Number

Yok

References

• 1. Rostrup M, Edwards JK, Abukalish M, Ezzabi M, Some D, Ritter H, et al. The methanol poisoning outbreaks in Libya 2013 and Kenya 2014. PloS One 2016;11(3):e0152676. PMID: 27030969
• 2. Barceloux DG, Randall Bond G, Krenzelok EP, Cooper H, Allister Vale J. American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning. J Toxicol Clin Toxicol. 2002;40:415–46. PMID: 12216995
• 3. McMartin KE, Makar AB, Martin G, Palese M, Tephly TR. Methanol poisoning. I. The role of formic acid in the development of metabolic acidosis in the monkey and the reversal by 4-methylpyrazole. Biochem Med 1975;13:319-33. PMID:2163
• 4. McMartin K, Jacobsen D, Hovda KE. Antidotes for poisoning by alcohols that form toxic metabolites. Brit J Clin Pharmacol. 2016;81(3):505-15. PMID: 26551875
• 5. Gulen M, Satar S, Avci A, Acehan S, Orhan U, Nazik H. Methanol poisoning in Turkey: Two outbreaks, a single center experience. Alcohol. 2020;88:83-90. PMID: 32702502
• 6. Aabakken L, Johansen KS, Rydningen EB, Bredesen JE, Ovrebo S, Jacobsen D. Osmolal and anion gaps in patients admitted to an emergency medical department. Hum Ex Toxicol. 1994;13:131-4. PMID: 7908810
• 7. Mahieu P, Hassoun A, Lauwerys R. Predictors of methanol intoxication with unfavourable outcome. Human Toxicol. 1989;8(2):135-7. PMID: 2501214
• 8. Liu JJ, Daya MR, Carrasquillo O, Kales SN: Prognostic factors in patients with methanol poisoning. J Toxicol Clin Toxicol. 1998;36:175-81. PMID: 9656972
• 9. Paasma R, Hovda KE, Hassanian-Moghaddam H, Brahmi N, Afshari R, Sandvik L, et al. Risk factors related to poor outcome after methanol poisoning and the relation between outcome and antidotes – a multicenter study. Clin Toxicol (Phila). 2012;50(9):823–831. PMID: 22992104
• 10. Hassanian-Moghaddam H, Zamani N, Kolahi AA, McDonald R, Hovda KE. Double trouble: methanol outbreak in the wake of the COVID-19 pandemic in Iran—a cross-sectional assessment. Crit Care, 2020;24(1),402. PMID: 32646475
• 11. Becker CE. Methanol Poisoning. J Emerg Med. 1983;1(1):51–8. PMID: 6386968
• 12. Jacobsen D, McMartin KE. Antidotes for methanol and ethylene glycol poisoning. J Toxicol Clin Toxicol. 1997;35(2):127–43. PMID: 9120880
• 13. Jacobsen D, Webb R, Collins TD, McMartin KE. Methanol and formate kinetics in late diagnosed methanol intoxication. Med Toxicol Adverse Drug Exp. 1988;3(5):418–23. PMID: 3193890
• 14. Sejersted OM, Jacobsen D, Ovrebo S, Jansen H. (1983). Formate concentrations in plasma from patients poisoned with methanol. Acta Med Scand. 1983;213(2):105-10. PMID: 6837328
• 15. Kruse, J.A. Methanol Poisoning. Intensive Care Med. 1992;18(7):391–7. PMID: 1469176
• 16. Smith SR, Smith SJM, Buckley BM. Lactate and Formate in Methanol Poisoning. Lancet 1982;1(8271):561–2. doi: 10.1016/S0140-6736(82)92067-0. PMID: 6120412
• 17. Kute VB, Godara SM, Shah PR, Gumber MR, Goplani KR, Vanikar AV, et al . Hemodialysis for methyl alcohol poisoning: a single-center experience . Saudi J Kidney Dis Transpl. 2012;23(1):37–43. PMID: 22237216
• 18. Liesivuori J, Savolainen H. Methanol and Formic Acid Toxicity: Biochemical Mechanisms. Pharmacol Toxicol. 1991;69(3):157–63. PMID: 1665561
• 19. Hantson P, Duprez T, Mahieu P. Neurotoxicity to the Basal Ganglia Shown by Magnetic Resonance Imaging (MRI) Following Poisoning by Methanol and Other Substances. J Toxicol Clin. Toxicol. 1997;35(2):151–61. PMID: 9120884
• 20. Kuteifan K, Oesterle´ H, Tajahmady T, Gutbub AM. Laplatte G. Necrosis and Haemorrhage of the Putamen in Methanol Poisoning Shown on MRI. Neuroradiology 1998;40(3):158–60. PMID: 9561519
• 21. Hovda KE, Hunderi OH, Tafjord AB, Dunlop O, Rudberg N, Jacobsen D. Methanol outbreak in Norway 2002-2004: Epidemiology, clinical features, and prognostic signs. J Intern Med 2005;258(2):181-90. PMID: 16018795
• 22. Roberts DM, Yates C, Megarbane B, Winchester JF, Maclaren R, Gosselin S, et al. Recommendations for the role of extracorporeal treatments in the management of acute methanol poisoning: a systematic review and consensus statement. Crit Care Med. 2015;43(2):461–72. PMID: 25493973
• 23. Zakharov S, Rulisek J, Nurieva O, Kotikova K, Navratil T, Komarc M, et al . Intermittent versus continuous renal replacement therapy in acute methanol poisoning: comparison of clinical effectiveness in mass poisoning outbreaks. Ann Intensive Care. 2017;7(1):77. PMID: 28730555
• 24. Hantson P, Wittebole X, Haufroid V. Ethanol therapy for methanol poisoning: Duration and problems. Eur J Emerg Med. 2002;9(3):278-9. PMID: 12394629